Servicio de Reumatología, Hospital Gral. San Martín de La Plata, Calle 1 y 70, La Plata, Argentina.
J Clin Rheumatol. 2011 Jan;17(1):18-22. doi: 10.1097/RHU.0b013e318204a6f8.
Ultrasound has demonstrated to be a highly sensitive tool in the evaluation of entheses in spondyloarthropathy (SpA) patients and improves the ability of clinical examination to detect enthesopathy.
The objectives of the study were to determine the prevalence of subclinical enthesopathy in SpA patients and to evaluate the reliability of ultrasound in the detection of abnormal findings indicative of enthesopathy.
Six hundred lower-limb entheses were assessed in 60 SpA patients without known history of entheseal involvement. Sixty rheumatoid arthritis patients and 30 control subjects were included as control groups. Clinical examination and ultrasound were consecutively performed at each of the entheses to detect signs indicative of enthesopathy. Images from 20 SpA patients were stored and afterward evaluated to determine the reliability of abnormal ultrasound findings.
Ultrasound detected a high prevalence of enthesopathy in SpA patients with respect to both rheumatoid arthritis patients and control subjects (P < 0.001 for both comparisons). In SpA patients, clinical examination detected enthesopathy in 56 (9.3%) of 600 entheses. In the remainder 544 clinically asymptomatic entheses (90.7%) (not painful and not swollen), ultrasound detected in 331 (60.8%) at least 1 ultrasound sign of enthesopathy. The intrareader and interreader agreement for all ultrasound abnormal findings was good to excellent.
The present study demonstrates a higher sensitivity of ultrasound with respect to physical examination in the detection of signs indicative of enthesopathy in SpA patients with an adequate interreader and intrareader reliability. Further study is needed about the prognostic value of the ultrasound findings for predicting clinical onset of entheseal involvement.
超声已被证明是评估脊柱关节炎（SpA）患者附着点的高度敏感工具，并提高了临床检查检测附着病的能力。
本研究的目的是确定 SpA 患者亚临床附着病的患病率，并评估超声在检测提示附着病的异常表现方面的可靠性。
对 60 例无已知附着受累史的 SpA 患者的 600 个下肢附着点进行评估。60 例类风湿关节炎患者和 30 例对照组作为对照组。在每个附着点处连续进行临床检查和超声检查，以检测提示附着病的征象。存储 20 例 SpA 患者的图像，然后评估以确定异常超声发现的可靠性。
超声检测到 SpA 患者附着病的患病率高于类风湿关节炎患者和对照组（两者比较均 P<0.001）。在 SpA 患者中，临床检查在 600 个附着点中发现了 56 个（9.3%）附着病。在其余 544 个临床无症状附着点（90.7%）（无疼痛且不肿胀）中，超声在 331 个（60.8%）附着点中至少检测到 1 个附着病的超声征象。所有超声异常发现的读者内和读者间一致性均为良好至极好。
本研究表明，超声在检测 SpA 患者附着病的征象方面比体格检查具有更高的敏感性，具有足够的读者内和读者间可靠性。需要进一步研究超声发现对预测附着受累临床发作的预后价值。
